From the Guidelines
Static flexibility, dynamic flexibility, ballistic flexibility, and PNF stretching are all effective types of stretching exercises for improving joint range of motion. According to the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis 1, a series of flexibility exercises for each of the major muscle–tendon units is recommended.
Key Characteristics of Stretching Exercises
- Frequency: ≥2–3 days/week is effective in improving joint range of motion, with the greatest gains occurring with daily exercise 1
- Intensity: Stretch to the point of feeling tightness or slight discomfort 1
- Time: Holding a static stretch for 10–30 s is recommended for most adults, while older persons may benefit from holding a stretch for 30–60 s 1
- Volume: A reasonable target is to perform 60 s of total stretching time for each flexibility exercise 1
- Pattern: Repetition of each flexibility exercise two to four times is recommended, and flexibility exercise is most effective when the muscle is warmed through light to moderate aerobic activity or passively through external methods such as moist heat packs or hot baths 1
Types of Stretching Exercises
- Static flexibility (active or passive)
- Dynamic flexibility
- Ballistic flexibility
- PNF stretching, which involves a 3–6 s contraction at 20%–75% maximum voluntary contraction followed by a 10–30 s assisted stretch 1 These types of stretching exercises can be incorporated into a routine 2-3 times weekly, focusing on major muscle groups, to improve flexibility and range of motion.
From the Research
Types of Stretching Exercises
There are several types of stretching exercises, including:
- Proprioceptive Neuromuscular Facilitation (PNF) stretching
- Static stretching
- Dynamic stretching
Effectiveness of Stretching Exercises
Research has shown that:
- PNF stretching and static stretching are equally effective in increasing hamstring flexibility 2
- Dynamic stretching can produce small-to-moderate performance improvements when completed within minutes of physical activity 3
- PNF stretching may be more effective than static stretching in improving function, elbow flexion range of motion, and reducing pain in patients with posttraumatic elbow stiffness 4
- PNF training can reduce pain and disability in individuals with chronic low back pain 5
- Both passive and PNF stretching techniques can improve range of motion in older people, with no significant differences between the two techniques 6
Comparison of Stretching Exercises
Studies have compared the effects of different stretching exercises, including:
- PNF stretching vs. static stretching: no significant difference in immediate improvements in hamstring flexibility 2
- PNF stretching vs. core strengthening: PNF training yielded a greater benefit for pain reduction and disability improvement 5
- PNF stretching vs. conventional physical therapy: PNF training improved pain and disability in patients with low back pain 5
- Passive stretching vs. PNF stretching: no significant differences in hip and shoulder range of motion in older people 6